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General NPI Number Information
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NPI Number | 1033545363
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Entity Type | Organization
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Legal Business Name | VICKI J SPARKS, MD, PC
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 114 SOUTHBRIDGE ST SUITE D
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6264
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Country | US
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Telephone | 210-340-2707
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Fax | 210-340-2746
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Provider Business Mailing Address
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Address Line | 114 SOUTHBRIDGE ST SUITE D
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6264
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Country | US
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Telephone | 210-340-2707
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Fax | 210-340-2746
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICKI JEAN SPARKS
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Credential | MD
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Telephone | 210-340-2707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | E6215
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License Number State | TX
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